Implications of analgesics use in osteoporotic-related pain treatment: focus on opioids

Abstract

SummaryBone loss is asymptomatic and will progress without pain and other symptoms until the occurrence of a fracture. The occurrence of a breaking bone induce acute pain determined and supported by a mechanical, inflammatory and neuropathic component. Very often the acute component evolves in a chronic musculoskeletal component. Overall objectives of the analgesic therapy can be summarized in pain relief, improving sleep, improve mobility, reduce anxiety, emotional component and depression. Osteoporosis is predominantly a condition of the elderly, more likely to have coexisting cardiovascular disease and age-related decline in renal function, receiving treatment for one or more comorbid conditions, taking multiple medications. Analgesic treatment with NSAIDs has negative effects on skeletal health and healing of the injured skeleton and increase risk of adverse events especially in older patients. Despite all opioids therapy represents a mainstay in the treatment of patients with moderate to severe pain, it can induce an endocrinopathy, which may affect bone metabolism. The negative effects of opioids on hormonal axis are not the same for all molecule and the choice of drug can be crucial in the treatment of patients with chronic pain.

Opioid‐induced hypogonadism: Pathophysiology, clinical and therapeutics review

“…88 However, other studies reported an association between OHG due to long-term intrathecal opioid in non-cancer pain and low bone density. 89 Furthermore, a murine femur fracture model with OHG showed diminished callus formation and endurable healing of bone fracture. 50 Receptor activator of nuclear factor κ-B (RANKL) has been recently linked to bone remodelling and correlated with a different mechanism to bone turnover processes.…”

“…Patients on long‐term opioids are reported as more prone to fracture due to dizziness . However, other studies reported an association between OHG due to long‐term intrathecal opioid in non‐cancer pain and low bone density . Furthermore, a murine femur fracture model with OHG showed diminished callus formation and endurable healing of bone fracture .…”

Pharmacological treatment of chronic non-malignant pain among elderly persons: an integrative review

“…The main side effects of opioids, however, are gastrointestinal, including constipation, nausea and vomiting 9 . These effects may be amplified by normal physiological changes in the elderly, such as increased gastric pH and reduced gastric and intestinal motility 17,32 .…”